What is the recommended dosing for ceftriaxone (Rocephin) for pneumonia (PNA)?

Ceftriaxone Dosing for Pneumonia

For community-acquired pneumonia (CAP), ceftriaxone should be administered at a dose of 1-2 g IV once daily, with 1 g daily being sufficient for most cases of CAP. 1, 2

Adult Dosing Recommendations

• Standard adult dosing: 1-2 g IV once daily 3

  • 1 g daily is as effective as 2 g daily for most community-acquired pneumonia cases 1, 2
  • Maximum daily dose should not exceed 4 g 3
  • Duration: 5-14 days (typically 7-10 days) 3

• Severe pneumonia/ICU patients: 2 g IV once daily 4

  • For penicillin-resistant Streptococcus pneumoniae: Consider higher dosing (2 g daily) 4

• Special considerations:

  • For patients with severe pneumonia (PORT risk class III-IV), ceftriaxone may be combined with a macrolide 4
  • For suspected MRSA: Add vancomycin (40-60 mg/kg/day) or clindamycin 4

Pediatric Dosing Recommendations

• Standard pediatric dosing: 50-75 mg/kg/day IV once daily or divided twice daily 3, 5

  • Maximum daily dose: 2 g 3

• For penicillin-resistant S. pneumoniae: 100 mg/kg/day 5

  • Maximum daily dose: 4 g 3

• Neonates: 50 mg/kg/day given every 24 hours for postnatal age ≤7 days; 50-75 mg/kg/day for postnatal age >7 days 5

  • Should be administered over 60 minutes in neonates to reduce risk of bilirubin encephalopathy 3

Duration of Therapy

• Typical duration: 7-14 days 3
• Continue therapy for at least 48-72 hours after clinical improvement 5
• Recent evidence supports shorter 5-day courses for uncomplicated pneumonia 5, 2
• For Streptococcus pyogenes infections, continue for at least 10 days 3

Administration Guidelines

• Intravenous administration should be over 30 minutes in adults 3
• For neonates, administer over 60 minutes to reduce risk of bilirubin encephalopathy 3
• Concentrations between 10-40 mg/mL are recommended for IV administration 3

Clinical Considerations

• No dosage adjustment is necessary for patients with renal or hepatic impairment 3
• Lower dosing (1 g daily) is associated with similar mortality rates but decreased C. difficile infection rates and shorter hospital stays compared to 2 g daily 2
• Ceftriaxone should not be used alone against Legionella pneumophila or atypical pathogens; consider adding a macrolide 6
• For surgical prophylaxis, a single dose of 1 g IV administered 30 minutes to 2 hours before surgery is recommended 3

Compatibility and Storage

• Do not use diluents containing calcium (e.g., Ringer's solution) 3
• Compatible with metronidazole at specific concentrations 3
• Incompatible with vancomycin, amsacrine, aminoglycosides, and fluconazole in admixtures 3
• After reconstitution, solutions remain stable at room temperature for 2 days or refrigerated for 10 days 3

The evidence strongly supports that 1 g daily dosing of ceftriaxone is as effective as 2 g daily for most cases of community-acquired pneumonia, with potential benefits of reduced C. difficile infections and shorter hospital stays 1, 2. For severe infections or resistant organisms, higher dosing may be warranted.